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1639923824 NPI number — CUSTOM SURGICAL CARE LLC

NPI Number: 1639923824
Health Care Provider/Practitioner: CUSTOM SURGICAL CARE LLC

Information about “1639923824” NPI (CUSTOM SURGICAL CARE LLC) exists in 1639923824 in HTML format HTML  |  1639923824 in plain Text format TXT  |  1639923824 in PDF (Portable Document Format) PDF  |  1639923824 in an XML format XML  formats.

NPI Number : 1639923824 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639923824",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CUSTOM SURGICAL CARE LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1S376 SUMMIT AVE STE 4C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAKBROOK TERRACE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60181-3966",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-232-4843",
    "MailingAddressFaxNumber": "847-779-6877",
    "FirstLinePracticeLocationAddress": "2350 RAVINE WAY STE 400",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLENVIEW",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60025-7621",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-232-4843",
    "PracticeLocationAddressFaxNumber": "847-779-6877",
    "EnumerationDate": "04/15/2024",
    "LastUpdateDate": "04/15/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "OSIPOVA",
    "AuthorizedOfficialFirstName": "MARIA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "773-551-5776",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QA1903X",
        "TaxonomyName": "Ambulatory Surgical Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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